05D2066966 CLIA NUMBER - HAWTHORNE DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2066966
  • Facility Name: HAWTHORNE DIALYSIS
  • Facility Address: 14204 PRAIRIE AVE
    HAWTHORNE, CA
    ZIP 90250
  • Facility Phone: 310 349-1174
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: EDGAR MUSNGI, MD
  • NPI Number: 1710229794
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2066966
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name HAWTHORNE DIALYSIS
Street 14204 PRAIRIE AVE
City HAWTHORNE
State CA
ZIP 90250
Phone 310 349-1174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2025
Certificate Expiration Date 10/6/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director EDGAR MUSNGI, MD

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This page was last updated on: 9/29/2025